WCB investigator strikes back

A newly hired claims investigator has already saved the Yukon Workers’ Compensation Health and Safety Board more than $1.

A newly hired claims investigator has already saved the Yukon Workers’ Compensation Health and Safety Board more than $1.5 million from fraudulent claims, officials reported at a briefing Tuesday.

Despite these savings, the board ended the financial year at a deficit, leaving rate reductions only a distant possibility.

Workers’ compensation investigations resulted in the termination of two claims during the financial year of 2007.

These resulted in projected savings of $1.5 million, representing monies that would have been paid in installments until each claimant had reached the age of 65.

“We’re looking now at whether we go back to collect overpayments, and whether we press charges,” said board president Valerie Royle.

The compensation board will refrain from releasing details of the fraudulent claimants until further investigations are completed.

Claims expenses dropped from $21,390,000 in 2006 to $17,125,000 in 2007, a difference of more than $4 million.

The change represents the first time that claims costs have decreased in five years, said an official release.

Improvements in claim management and monitoring of claim duration have also added to savings incurred by the investigator, said Royle.

Despite these financial overtures, the board ended the 2007 financial year with a $6-million deficit, due mainly to poor showings in its investment portfolio.

This contrasted with a $3-million surplus in 2006.

“Yes, the deficit is $6.5 million, but the good news here, folks, is the reduction in claims costs,” said board chair Craig Tuton.

Tuton also pointed to a $200,000 reduction in administration costs.

“I think that the financial statements that we’re able to present to the public today are great news. The investments will take care of themselves, we really can’t control what the investment market is going to do,” he said.

Officials couldn’t say whether reduced claims costs would eventually signal rate reductions.

The board is working with stakeholders to “achieve that end,” said Tuton.

The investigator, who was hired in July 2007, has a mandate to examine potentially fraudulent claims such as over-billing by health-care providers and inaccurate rate payment by employers.

The investigator is also in place to tackle internal fraud cases stemming from board employees, said Royle.

The Yukon is the second-last province or territory in Canada to create the investigator position. Prince Edward Island still does not have such a position.

The Yukon Workers’ Compensation Health and Safety Board has consistently received phone-in tips on bogus claims, but couldn’t adequately respond until the investigator was brought in last year.

As a typical scenario is a man on workers’ compensation for a back injury, reported by a neighbour after he’s seen fixing his roof, said Royle.

“We didn’t have someone to go out and do that investigation, so we’d have to find somebody, and by the time you do find somebody, the person’s off the roof and the opportunity’s missed,” she said.

The investigator also allows closer management of claimants who have left the territory.

If a claimant moves outside the Yukon and settles within another part of Canada, responsibility for claim management typically accrues to the compensation board working within that region.

Unfortunately, local compensation boards rarely gave high priority to Yukon-based claimants, said Royle.

 “What we found was we really needed our own person, particularly for claims outside the territory … now we’ve got an additional set of eyes just for us on those claims,” she said.